| Title of Invention | STOMACH INVAGINATION METHOD AND APPARATUS |
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| Abstract | A system for creating an invaginated portion in a stomach comprises a suction device and a securing member. The suction device comprises a suction head operable to provide suction, a shaft connected to the suction head, and a vacuum lumen in fluid communication with the suction head. The suction head and vacuum lumen are operable to induce a vacuum adjacent to tissue. The suction device is further operable to create an invaginated portion with the tissue. The securing member is operable to substantially maintain the configuration of the invaginated portion of tissue. The suction device may comprise gripping jaw members having teeth. The securing member may comprise an adhesive and/or sutures and the like. The system may be used to create invaginated portions within a stomach. Such invaginated portions may reduce stomach volume to address obesity or other conditions. |
| Full Text | END5872USNP-0540932 - 1 - STOMACH INVAGINAT10N MHTHOD AND APPARATUS John Sheets Mark S. Ortiz Frederick E. Shelton, IV BACKGROUND [0001] Obesity has been a problem for many years. A variet) of methods and devices have been used to try to address obesity in patients, including gastric bypasses and implanted devices. Biosurgical adhesives have also been used in a variety of ways in various medical procedures. An exemplary adhesive is disclosed in U.S. Pub. No. 2004/0190975. the disclosure of which is incorporated by reference herein. While several systems and methods have been made and used for addressing obesity, and while adhesives have been used in various other medical procedures, it is believed that no one prior to the inventors has made or used the invention described in the appended claims. BRIHF DESCRIPTION Of THE DRAWINGS [0002] While the specification concludes with claims which particularly point out and distinctly claim the invention, it is believed the present invention will be better understood from the following description of certain examples taken in conjunction with the accompanying drawings, in which like reference numerals identify the same elements and in which: [0003] FIG. 1 depicts an exemplary suction device within a stomach, and an exemplary method for applying adhesive to an outer wall of the stomach: [0004] FIG. 2 depicts a partial cross-sectional view of the suction device of FIG. 1 engaged with a stomach: END5872USNP-0540932 - 2 - [0005] FIG. 3 depicts a cross-sectional view of exemplary invaginated stomach portions; [0006] FIG. 4 depicts a cross-sectional view of the invaginated stomach portions oi FIG. 3 detached from the inner stomach wall; [0007] FIG. 5 depicts a plan view of an exemplary adhesive matrix applied to an outer stomach wall; [0008] FIG. 6 depicts a plan view of the outer stomach wall of FIG. 5 after the wall has been invaginated; [0009] FIG. 7 depicts a partial view of an exemplary alternative imagination device: [0010] FIG. 8 depicts the imagination device of FIG. 7 performing an exemplar) aci of imagination; [0011] FIG. 9 depicts a partial cross-sectional view, taken along line 9-9 of FIG. 8. of the imagination device of FIG. 7 performing an exemplary act of imagination; [0012] FIG. 10 depicts a perspective view of an exemplar} alternative gripping jaw member; [0013] FIG. 1 1 depicts a partial cross-sectional view of an exemplar) alternative imagination device with the gripping jaw member of FIG. 10: and [0014] FIG. 12 depicts a partial cross-sectional view of the device of FIG. 1 1 with the gripping jaw members in a generally open position. DETAILED DESCRIPTION [0015] The following description of certain examples of the invention should not be used to limit the scope of the present invention. Other examples, features, aspects, embodiments, and advantages of the invention will become apparent to those skilled in the art from the following description, which is by way of END5872USNP-0540932 illustration, one of the best modes contemplated for carrying out the invention. As will be realized, the invention is capable of other different and obvious aspects, all without departing from the invention. Accordingly, the drawings and descriptions should be regarded as illustrative in nature and not restrictive. [0016] As shown in FIG. 1, an exemplary invagination system (10) comprises a suction device (20) and an endoseopic adhesive applier (40). In the present example, suction device (20) is disposed within a stomach (100); while adhesive applier (40) is positioned outside stomach (100). As shown in FIGS. 1-3. and as will be described in greater detail below, invagination system (10) is operable to create several invaginated portions (102) of stomach (100). The creation of such invaginated portions (102) may ultimatel\ reduce the volume of stomach (100). [0017] The suction device (20) comprises a head (22) coupled with a flexible lube (24). As shown head (22) has an annular, outwardly flared rim (26). and is in fluid communication with flexible tube (24). Rim (26) is configured to sealingly engage an inner stomach surface (104). As shown in FIG. 2. with rim (26) engaged with inner stomach surface (104). a vacuum ma\ be provided through flexible tube (24) to draw a portion ol' stomach (100) into head (22). thereby creating an invaginated portion (102) of stomach (100). It will be appreciated that the illustrated configuration for head (22) is merely exemplary, and that head (22) may alternatively comprise a varich of alternative features and configurations. [0018] As shown in FIG. 1, adhesive applier (40) ol' the present example is configured to fit within a working channel of an endoscope (50). Adhesive applier (40) in this example is a conventional endoseopic adhesive applier. though any suitable alternative may be used. Adhesive applier (40) is operable to dispense an adhesive (60) on an outer surface (106) (e.g.. serosal surface) of stomach (100). Adhesive (60) may comprise a cyanoacrylaic, an isocyanate, or any other suitable substance. END5872USNP-0540932 - 4- [0019] As shown in FIG. 5, in one exemplary use, a matrix cloth (70) may be applied to outer surface (106) of stomach (100) before adhesive (60) is applied. Matrix cloth (70) may comprise a plurality of cells [72.). such is in honeycomb configuration by way of example only, f.ach cell (72) may comprise an activator substance that is configured to react with adhesive (60). In particular, adhesive (60) may be configured such that it is not operable to satisfactorily adhere tissue unless placed in contact with the activator substance. Alternatively, matrix cloth (70) may lack an activator substance. By way ol example only, to the extent a matrix cloth (70) (70) may comprise polyester or any other suitable material or materials. [0020] In another embodiment, matrix cloth (70) contains adhesive (60). such that a separate applier (40) is not needed to apply adhesive (60). For instance, cells (72) may contain adhesive (60). Alternatively, matrix cloth (70) material may itself be adhesive, with no adhesive (60) being provided within cells (72). In this variation, portions of matrix cloth (70) may adhere to outer surface (106) and/or to other portions of matrix cloth (70). This may permit contact between adjacent outer surface (106) portions through voids provided by empty cells (72). which may result in fusion of such adjacent outer surface portions (106). Alternatively, matrix cloth (70) may be substituted with any suitable alternative, supplemented with other structures or substances. ov may K-omitted altogether. To the extent that a matrix cloth (70) is used, suitable methods for applying matrix cloth (70) will be apparent to those ol' ordinary skill in the art. [0021] In the present example, as shown in FIG. 2. head (22) is applied to stomach (100) opposite of applied adhesive (60) and matrix cloth (72). When suction is used via flexible tube (24) and head (22) to create invaginated portion (102) of stomach (100). adhesive (60) and matrix cloth (72) are also pulled in with invaginated portion (102). As shown in FIGS. 2 and 6. adhesive (60) is entrained in the interior portion of invaginated portion (102). It will be END5872USNP-0540932 - 5- apprcciatcd that adhesive (60) may provide sufficient adhesion to maintain the configuration of invaginatcd portion (102). In another embodiment, adhesive (60) is applied after invaginaticd portion (102) has been created, for instance, adhesive applier (40) may be pressed into the well provided in outer surface (106) by invaginatcd portion (102). Adhesive (60) may be applied until it begins excreting from within the well or until otherwise desired. [0022] In one variation, and as shown in FIG. 3, one or more sutures (80) are applied at or near the base of each invaginatcd portion (102) to further assist the maintenance of invaginated portion (102) configurations (and/or for other purposes). Sutures (80) may also cut of blood circulation for each invaginated portion (102). resulting in the death of tissue forming each invaginatcd portion (102). Of course, any suitable alternative to sutures (80) ma\ be used. including but not limited to bands, clips, staples, etc. Alternatively, sutures (80) may be substituted, supplemented, or omitted altogether, as desired. [0023] In one embodiment, as shown in FIG. 4 invaginated portions (102) maeventually separate from stomach (100) (e.g.. alter at least a portion of the tissue forming invaginated portions (102) necroses or dies). Such separated invaginated portions (102) may thereafter pass through the gastrointestinal tract. At sites (108) where each invaginated portion (102) was formerly located, a remaining amount of adhesive (60) may prevent an opening from forming through stomach (100). In addition, or in the alternative, scar tissue or other tissue fusion may prevent the formation of such openings. Ultimatel). in the present example, the structural integrity oi' stomach (100) will be preserved despite the separation ol' invaginaled portions (102) from their respective sites (108). It will also be appreciated that the separation oi' invaginated portions (102) may cause a reduction in acid producing surface. To the extent that imagination system (10) is used to treat obesity, such a reduction in acid producing surface may further provide a desirable malabsorbativc result. Such a malabsorbative result may compliment END5872USNP-0540932 -6- reduction in stomach volume caused by invagination as a means lor addressing obesity. [0024] FIGS. 7-9 depict a gripping instrument (120) that may be used as an alternative to suction device (20). As shown, gripping instrument (120) comprises a shaft (122) and a pair of gripping jaw members (124). Shaft (122) is generally llcxible, and is configured to be introduced to a patient's stomach (100) through the patient's esophagus (e.g., endoscopically. etc.). As will be described in greater detail below, shaft (122) further comprises a lumen (ik.t shown) through which a vacuum may be provided. [0025] Gripping jaw members (124) are pivotally connected relative to shaft (122). such that jaw members (124) may be selectively provided in an open or closed positions. Each gripping jaw member (124) has a plurality oi' teeth (126). Teeth (126) are configured to grip tissue, such as inner stomach surface (104). Gripping jaw members (124) may be operable to open and close via cables (not shown). Cables in the present example extend through shaft (122) to a user input device (not shown). Of course, any suitable alternative to cables may be used to open and/or close gripping jaw members (124). [0026) Gripping instrument (120) of the present example further comprises a vacuum port (140). Vacuum port (140) may have a configuration similar to tiiat oi head (22) on suction device (20). In the present example, vacuum port (140) has a diameter that is less than the diameter of head (22) on suction device (20). Vacuum port (140) is in fluid communication with vacuum lumen of shaft (122). Vacuum port (140) may be used to secure inner stomach surface (104) relative to gripping jaw members (124). such as before gripping jaw members (124) are used to grip inner stomach surface (104). [0027] In use. matrix cloth (70) and adhesive (60) are applied to outer stomach surface (106). Gripping instrument (120) is positioned adjacent inner stomach surface (104). substantially opposite of matrix cloth (70) and adhesive (60). END5872USNP-0540932 -7- With gripping jaw members (124) in an open position, vacuum is applied through vacuum port (140). securing inner stomach surface (104) relative to gripping jaw members (124). as shown in FIG. 7. Gripping jaw members (124) are then actuated to a substantially closed position while gripping inner stomach surface (104) with teeth (126). as shown in FIGS. H-9. An invaginatcd portion (202) is thereby created in stomach (100). In the present example, invaginatcd portion (202) is similar to invaginaled portion (102). except that invaginated portion (202) is generally wider in one dimension. It will therefore be appreciated that creation ol~ invaginated portion (202) ma\ result in greater reduction of stomach (100) volume than creation of invaginated portion (102). It will also be appreciated that the base oi' invaginated portion (202) may be further secured with one or more sutures, bands, clips, staples, etc. [0028] An exemplary variation of gripping instrument (120) is shown in FIGS. 10-12. In this variation, gripping instrument (220) comprises a shaft (222) and a pair of gripping jaw members (224). Shaft (222) is generally flexible, and is configured to be introduced to a patient's stomach (100) through the patient's esophagus (e.g.. endoscopically. etc.). As will be described in greater detail below, shaft (222) further comprises a lumen (250) through which a vacuum may be provided. [0029] Gripping jaw members (224) are pivotally connected relative to shaft (222). such that jaw members (224) may be selectively provided in an open or closed positions. Hach gripping jaw member (224) has a plurality oi' teeth (226). Teeth (226) are configured to grip tissue, such as inner stomach surface (104). Gripping jaw members (224) may be operable to open and close via cables (230). Gables (230) in the present example extend through shaft (222) to a user input device (not shown). Of course, any suitable alternative to cables (230) may be used to open and/or close gripping jaw members (224). END5872USNP-0540932 -8- [0030] liach gripping jaw member (224) comprises a generally spherically-shaped joint portion (228). Joint portions (228) are configured to (222) while gripping jaw members (224) are in an open position. 1-ach gripping jaw member (224) also has a cup-like configuration, which is configured to provide a vacuum chamber (240). Such vacuum chambers (240) are in fluid communication with lumen (250). such that a vacuum may be provided within vacuum chambers (240) via lumen (250). In another variation, a cover (not shown) having a plurality of apertures is provided over each vacuum chamber (240). Alternatively, any other structural variation ol' gripping jaw members (224) may be used. [0031] While lumen (250) is depicted as generally being the interior of shaft (222). it will be appreciated that lumen (250) may alternatively be provided by a separate member (not shown) inserted through shall (^22). Other structural variations will be apparent to those of ordinary skill in the art. [0032] In an exemplary use, gripping instrument (220) is used in a manner similar to the use of gripping instrument (120) described above. However, instead of suction being provided through vacuum port (140). suction is provided through vacuum chambers (240) ol' gripping jaw members (224). Such suction may be provided before and during the gripping of inner stomach surface (104) of teeth (226). and may assist teeth (226) in the gripping of inner stomach surface (104). Suction may continue to be provided as gripping jaw members (224) are brought to a closed position, whereupon an invaginated portion (202) is created. [0033] As will be appreciated by those of ordinary skill in the art. the creation oi invaginated portions (102. 202) may result in a reduction of stomach (100) volume. Such reduction in stomach (100) volume may (or may not) provide a method for treating morbid obesity in a patient, and/or may provide other results. Other suitable structural variations of suction device (20) and gripping END5872USNP-0540932 -9- instrumenls (120. 220), as well as variations of uses for the same, will be apparent to those of ordinary skill in the art. [0034] It will be appreciated that the invagination systems (10) described herein, including variations of the same, may be used in laparascopic. endosenpk-. open, and/or other surgical settings, including combinations thereof. [0035] Hmbodiments of the present invention have application in conventional endoscopic and open surgical instrumentation as well as application in robotic-assisted surgery. |0036| Embodiments of the devices disclosed herein can be designed to be disposed of after a single use, or they can be designed to be used multiple times. Embodiments may, in either or both cases, be reconditioned for reuse after at least one use. Reconditioning may include any combination of the steps of disassembly of the device, followed by cleaning or replacement of particular pieces, and subsequent reassembly. In particular, embodiments of the device may be disassembled, and am number ol the particular pieces or parts oi ilic device may be selectively replaced or removed in any combination. Upon cleaning and/or replacement of particular parts, embodiments of the device may be reassembled for subsequent use either at a reconditioning facility, or by a surgical team immediately prior to a surgical procedure. Those skilled in the art will appreciate that reconditioning of a device may utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly I se ol such techniques, and the resulting reconditioned device, are all within the scope of the present application. [0037] By way of example only, embodiments described herein may be processed before surgery. First, a new or used instrument may be obtained and if necessary cleaned. The instrument may then be sterilized. In one sterilization technique, the instrument is placed in a closed an sealed container, such as a plastic or TYVEK bag. The container and instrument may then be placed in a END5872USNP-0540932 - 10 - field of radiation that can penetrate the container, such as gamma radiation, x-rays. or high-energy electrons. The radiation may kill bacteria on the instrument and in the container. The sterilized instrument may then be stored in the sterile container, the sealed container may keep the instrument sterile until it is opened in a medical facility. A device may also be sterilized using any other technique known in the art, including but not limited to beta or gamma radiation, ethylene oxide, or steam. [0038] Having shown and described various embodiments of the present invention, further adaptations of the methods and systems described herein may be accomplished by appropriate modifications by one of ordinary skill in the art without departing from the scope of the present invention. Several of such potential modifications have been mentioned, and others will be apparent to those skilled in the art. For instance, the examples, embodiments, geometries, materials, dimensions, ratios, steps, and the like discussed above are illustrative and are not required. Accordingly, the scope of the present invention should be considered in terms of the following claims and is understood not to be limited to the details of structure and operation shown and described in the specification and drawings. END5872USNP-0540932 - 11 -What is claimed is: 1. A system for creating an invaginatcd portion in a stomach, the system comprising: (a) a suction device, wherein the suction device comprises: (i) a suction head operable to provide suction. (ii) a shall, wherein the suction head is connected to the shaft, and (iii) a vacuum lumen in fluid communication with the suction head, wherein the suction device is configured for the suction head to be placed adjacent to tissue, wherein the suction head and vacuum lumen are operable to induce a vacuum adjacent to the tissue, wherein the suction device is further operable to create an invaginated portion with the tissue: and (b) a securing member, wherein the securing member is operable to substantially maintain the configuration of the invaginated portion of tissue. 2. The system of claim 1. wherein the suction head has an annular. oulwardh flared rim. 3. The system of claim 1. wherein the suction head further comprises a plurality of gripping jaw members, wherein the gripping jaw members arc operable to be placed in an open position or a closed position. 4. The system of claim 3. wherein the suction head further comprises a vacuum port positioned near the gripping jaw members. 5. The system of claim 3. wherein the gripping jaw members each comprise a vaccum chamber. END5872USNP-0540932 - 12- 6. The system of claim 3, wherein each of the gripping jaw members comprises a generally spherically-shaped joint portion, wherein at least part of the joint portions overlap when the gripping jaw members are in an open position. 7. The system of claim 1, wherein the securing member comprises an adhesive. 8. The system of claim 7, wherein the adhesive comprises one or both of a cyanoacrylate or an isocyanate. 9. The system of claim 7, wherein the securing member further comprises an activator configured to activate the adhesive. 10. The system of claim 7, wherein the securing member further comprises a matrix, wherein the activator is provided within the matrix. A system for creating an invaginated portion in a stomach comprises a suction device and a securing member. The suction device comprises a suction head operable to provide suction, a shaft connected to the suction head, and a vacuum lumen in fluid communication with the suction head. The suction head and vacuum lumen are operable to induce a vacuum adjacent to tissue. The suction device is further operable to create an invaginated portion with the tissue. The securing member is operable to substantially maintain the configuration of the invaginated portion of tissue. The suction device may comprise gripping jaw members having teeth. The securing member may comprise an adhesive and/or sutures and the like. The system may be used to create invaginated portions within a stomach. Such invaginated portions may reduce stomach volume to address obesity or other conditions. |
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| Patent Number | 279645 | ||||||||||||
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| Indian Patent Application Number | 1359/KOL/2007 | ||||||||||||
| PG Journal Number | 05/2017 | ||||||||||||
| Publication Date | 03-Feb-2017 | ||||||||||||
| Grant Date | 27-Jan-2017 | ||||||||||||
| Date of Filing | 04-Oct-2007 | ||||||||||||
| Name of Patentee | ETHICON ENDO-SURGERY, INC | ||||||||||||
| Applicant Address | 4545 CREEK ROAD CINCINNATI, OH | ||||||||||||
Inventors:
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| PCT International Classification Number | A 61 B | ||||||||||||
| PCT International Application Number | N/A | ||||||||||||
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